An interdisciplinary student-led multifaceted intervention addressing overuse of broad-spectrum antibiotics for patients with penicillin allergies.

Background: Though 15% of hospitalized patients have a documented penicillin (PCN) allergy, fewer than 1% have an IgE-mediated reaction that necessitates avoidance of β-lactam antibiotics.

Objective: Our interdisciplinary team of medical and nursing students led and executed a two-pronged quality improvement intervention to reduce prescribing of non-β-lactam antibiotics (NBLs) for patients with reported PCN allergies. To the best of our knowledge, this is the first multidisciplinary student-led intervention aimed at educating providers on low-risk penicillin allergy and encouraging best antibiotic prescribing practices.

Seasonal Effects on Postoperative Complications After Spinal Surgery: A National Database Analysis.

Objective: To investigate the role of seasonality on postoperative complications after spinal surgery.

Methods: Data were obtained from the American College of Surgeons National Surgical Quality Improvement Program database from 2011 to 2018. Current Procedural Terminology codes were used to identify the following procedures: posterior cervical decompression and fusion, cervical laminoplasty, posterior lumbar fusion, lumbar laminectomy, and spinal deformity surgery.

Screw-only fibular construct for Weber B ankle fractures: A retrospective clinical and cost comparison to assess feasibility for resource-limited settings.

Introduction: Ankle fractures are one of the most common injuries sustained worldwide, with the majority being isolated lateral malleolus fractures. The majority of the world's population live in Low and Middle Income Countries (LMIC), where implant cost may limit surgical treatment of ankle fractures. We investigate if Weber B ankle fractures could be effectively treated with a lower-cost technique using two screws between the fibula and the tibia to neutralize an interfragmentary lag screw.

Analysis of physician recipients of recognition awards from the American Academy of Physical Medicine and Rehabilitation by Race and Ethnicity.

Background: Medical society recognition awards are important resources for physicians in advancing their careers. There is a need to better understand the representation of physician recipients by race and ethnicity, especially in women with intersectional identities.

Objective: To assess the proportions of American Academy of Physical Medicine and Rehabilitation (AAPM&R) award recipients by race and ethnicity and the intersection of gender.

Identification of Anterior Cervical Spinal Instrumentation Using a Smartphone Application Powered by Machine Learning.

Study Design: Cross-sectional study.

Objective: The purpose of this study is to develop and validate a machine learning algorithm for the automated identification of anterior cervical discectomy and fusion (ACDF) plates from smartphone images of anterior-posterior (AP) cervical spine radiographs.

Summary Of Background Data: Identification of existing instrumentation is a critical step in planning revision surgery for ACDF.

Case studies from the digital clinic: integrating digital phenotyping and clinical practice into today's world.

The following case series provides several examples from the Digital Clinic, an outpatient mental health program which uses smartphone technology to augment traditional mental health care. The themes highlighted in this piece, expanding emotional-awareness, symptom tracking, and medication management, provide real-clinical examples of how the Digital Clinic offered remote mental health care to a diverse group of people. Furthermore, the following piece demonstrates to practicing clinicians how digital technologies, like smartphone apps, can diversify methods of clinical engagement, assist with collecting health metrics in a safe and ethical manner, and promote person centred care.

Investigating Associations Between Screen Time and Symptomatology in Individuals With Serious Mental Illness: Longitudinal Observational Study.

Background: Increasing screen time exposure from digital devices like smartphones has shown a variety of mixed associations with cognition, behavior, and well-being in adults and children but little is known about its associations with symptomatology in individuals with serious mental illness.

Objective: To determine the range of associations between screen time and symptoms of individuals with mental illness, we utilized a method called specification curve analysis.

Methods: In this observational study, we recruited smartphone-owning adults (≥18 years old) with schizophrenia and healthy controls.

Anomaly detection to predict relapse risk in schizophrenia.

The integration of technology in clinical care is growing rapidly and has become especially relevant during the global COVID-19 pandemic. Smartphone-based digital phenotyping, or the use of integrated sensors to identify patterns in behavior and symptomatology, has shown potential in detecting subtle moment-to-moment changes. These changes, often referred to as anomalies, represent significant deviations from an individual's baseline, may be useful in informing the risk of relapse in serious mental illness.

Impact of dynamic greenspace exposure on symptomatology in individuals with schizophrenia.

There are currently many tools available for capturing and defining the context of one's environment. Digital phenotyping, the use of technology and sensors to capture moment-to-moment behavior, has shown potential in quantifying the lived experience of mental illness and in the identification of individualized targets related to recovery. Environmental data suggests that greenspace may have a restorative capacity on mental health.

Digital Health Around Clinical High Risk and First-Episode Psychosis.

Purpose Of Review: This review aims to examine relapse definitions and risk factors in psychosis as well as the role of technology in relapse predictions and risk modeling.

Recent Findings: There is currently no standard definition for relapse. Therefore, there is a need for data models that can account for the variety of factors involved in defining relapse.

Technology Evaluation and Assessment Criteria for Health Apps (TEACH-Apps): Pilot Study.

Background: Despite the emergence of app evaluation tools, there remains no well-defined process receptive to diverse local needs, rigorous standards, and current content. The need for such a process to assist in the implementation of app evaluation across all medical fields is evident. Such a process has the potential to increase stakeholder engagement and catalyze interest and engagement with present-day app evaluation models.

Do neurobiological differences exist between paranoid and non-paranoid schizophrenia? Findings from the bipolar schizophrenia network on intermediate phenotypes study.

Subtypes of schizophrenia, constructed using clinical phenomenology to resolve illness heterogeneity, have faced criticism due to overlapping symptomatology and longitudinal instability; they were therefore dropped from the Diagnostic Statistical Manual-5. Cognitive and imaging findings comparing paranoid (P-SZ) and non-paranoid (disorganized, residual and undifferentiated; NP-SZ) schizophrenia have been limited due to small sample sizes. We assessed P-SZ and NP-SZ using symptomatology, cognition and brain structure and predicted that there would be few neurobiological differences.

Towards clinically actionable digital phenotyping targets in schizophrenia.

Digital phenotyping has potential to quantify the lived experience of mental illness and generate real-time, actionable results related to recovery, such as the case of social rhythms in individuals with bipolar disorder. However, passive data features for social rhythm clinical targets in individuals with schizophrenia have yet to be studied. In this paper, we explore the relationship between active and passive data by focusing on temporal stability and variance at an individual level as well as large-scale associations on a population level to gain clinically actionable information regarding social rhythms.

Longitudinal trends in the quality, effectiveness and attributes of highly rated smartphone health apps.

Background: While there are numerous mental health apps on the market today, less is known about their safety and quality. This study aims to offer a longitudinal perspective on the nature of high visibility apps for common mental health and physical health conditions.

Methods: In July 2019, we selected the 10 top search-returned apps in the Apple App Store and Android Google Play Store using six keyword terms: depression, anxiety, schizophrenia, addiction, high blood pressure and diabetes.

Digital Opportunities for Outcomes in Recovery Services (DOORS): A Pragmatic Hands-On Group Approach Toward Increasing Digital Health and Smartphone Competencies, Autonomy, Relatedness, and Alliance for Those With Serious Mental Illness.

Digital health technologies such as smartphones present the potential for increased access to care and on-demand services. However, many patients with serious mental illnesses (eg, schizophrenia) have not been offered the digital health training necessary to fully utilize these innovative approaches. To bridge this digital divide in knowledge and skills, we created a hands-on and interactive training program grounded in self-determination theory, technology use cases, and the therapeutic alliance.

Assessing Cognition Outside of the Clinic: Smartphones and Sensors for Cognitive Assessment Across Diverse Psychiatric Disorders.

Traditionally, the assessment of cognition and the administration of cognitive therapies has been performed in the clinic, but with modern technology, this clinic-centric view is changing. This article explores the landscape of digital devices used to measure cognition in settings outside the clinic. These devices range in mobility from user-friendly mobile devices to setting-specific devices able to provide powerful, robust cognitive therapy and living assistance in the comfort of a patient's home.

Using a Smartphone App to Identify Clinically Relevant Behavior Trends Symptom Report, Cognition Scores, and Exercise Levels: A Case Series.

The use of smartphone apps for research and clinical care in mental health has become increasingly popular, especially within youth mental health. In particular, digital phenotyping, the monitoring of data streams from a smartphone to identify proxies for functional outcomes like steps, sleep, and sociability, is of interest due to the ability to monitor these multiple relevant indications of clinically symptomatic behavior. However, scientific progress in this field has been slow due to high heterogeneity among smartphone apps and lack of reproducibility.

NRXN1 is associated with enlargement of the temporal horns of the lateral ventricles in psychosis.

Schizophrenia, Schizoaffective, and Bipolar disorders share behavioral and phenomenological traits, intermediate phenotypes, and some associated genetic loci with pleiotropic effects. Volumetric abnormalities in brain structures are among the intermediate phenotypes consistently reported associated with these disorders. In order to examine the genetic underpinnings of these structural brain modifications, we performed genome-wide association analyses (GWAS) on 60 quantitative structural brain MRI phenotypes in a sample of 777 subjects (483 cases and 294 controls pooled together).

Assessing the potential of longitudinal smartphone based cognitive assessment in schizophrenia: A naturalistic pilot study.

Background: Although cognition is a core symptom of schizophrenia and associated with functional impairment, the degree of training for and time associated with its assessment makes it difficult to routinely monitor in clinic care.Smartphone based cognitive assessments could serve as a tool to measure cognition in real time as well as being easily scalable for broad use.Combined with other data gathered from smartphone sensors such as steps, sleep, and self-reported symptoms - capturing 'cognition in context' could provide a powerful new tool for assessing the functional burden of disease in schizophrenia.

Digital mental health apps and the therapeutic alliance: initial review.

Background: As mental healthcare expands to smartphone apps and other technologies that may offer therapeutic interventions without a therapist involved, it is important to assess the impact of non-traditional therapeutic relationships.AimsTo determine if there were any meaningful data regarding the digital therapeutic alliance in smartphone interventions for serious mental illnesses.

Method: A literature search was conducted in four databases (PubMed, PsycINFO, Embase and Web of Science).